Congressional leaders moved yesterday to work bipartisanly and protect the “cost sharing reduction” (CSR) payments that help lower-income policyholders (between 100% and 250% of the federal poverty level) pay for “silver plans” on the Affordable Care Act individual marketplace. Following the Senate’s rejection of three plans to repeal some portion of the ACA, Donald Trump has been threatening to cut off those payments as a way to kill the ACA by executive fiat.
The CSR payments are in addition to the savings ACA policyholders get from the premium tax subsidy. Axios provides this map showing that South Dakota is among states where a majority of ACA policyholders receive CSR assistance:
According to the Kaiser Family Foundation, as of February 2017, 16,144 of South Dakota’s 27,314 ACA marketplace policyholders enjoyed lower health insurance premiums thanks to CSR payments. That’s 59%. If Trump reneges on CSR payments, insurers will have to recoup their losses by jacking premiums even higher, perhaps an extra 20%. That hike would hit all 27,314 South Dakota enrollees.
That’s 27,314 rural people about whom Donald Trump is forgetting. At least Congress is showing some signs of putting old slogans behind them and focusing on working together to serve all Americans amidst the gap in leadership and practical problem-solving created by the feckless Executive Branch.
Hoping this is on topic.
Notice that Kentucky is also on the high end of the subsidy stick. Last night I heard an interview with their Sen. Paul. He’s taking my lead. Maybe you remember the discussion I had with Don Coyote about COSTCO being socialism/collectivism? I asserted that, “Maybe COSTCO should sell health insurance. COSTCO has 85 million members and buying things we all need as a group is almost always cheaper.”
Rand Paul is now introducing talk in the Senate to allow groups (Chamber of Commerce, NRA, buyers clubs, PERA, AARP, teachers unions etc.) to sell group healthcare insurance and collective pharmaceutical prices to … wait for it, allow their members to buy as a group and save money.
Call is socialized health care or call it toadstool pancakes, if we can make it save money and insure more people let’s do it. The label is unimportant.
McConnell and Paul’s Kentucky: 78% of enrollees get premium tax credits, 51% get CSR. Rubio’s Florida: 93% of enrollees get PTC, 75% CSR. Cruz and Cornyn’s Texas: 86% PTC, 63% CSR.
Nationwide, 10.3 million Americans on the ACA individual marketplaces, 84% get PTC, 57% CSR. 5.9 million Americans whom Donald Trump would straight-up hose, out of sheer spite, with no plan beyond burning Barack Obama in policy effigy.
That’s too many voters to disenfranchise. Republicans in Washington wouldn’t do it and I’m thinking Trump won’t either. They’re all mouth and no trousers!!
Trump isn’t thinking about that math. McConnell may be. Rand Paul’s Libertarianism transcends any such crass electoral calculations… or relies on enough of his colleagues to be pragmatists to allow him the luxury of philosophical grandstanding that will never turn into enacted law (much like the entire GOP’s shouts of “Repeal ObamaCare!” for the last seven years when they could count on Barack Obama’s sensible veto to protect them from the real, disastrous implications of their words).